Under The Knife

Getting Technical

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On Tuesday, Michael Schmidt of The New York Timeswrote an article about the pace of injuries in baseball. (Actually, he wrote two, because this one is well worth checking out as well, though any regular reader knows that this type of thing is going on not just with teams, but right here. The categories on the board should look familiar.) There's no long historical database where we can really check trends or make any statistically valid argument one way or the other, but I can use data to show there's some issues that aren't really considered, here:

Using the data above, I just don't see where Schmidt's conclusion comes from, that this season is any worse than others. There's variation, but I'm hard-pressed to say that it's anything other than random. If it were PEDs, wouldn't we have seen injuries go down in the heart of the "Steroid Era" rather than continuing up? If it were amphetamines, wouldn't we have expected significantly lower totals when the stuff was being handed out like candy? There's hundreds of ways of looking at this data, from my chart above to the press release that MLB put out on Opening Day about the lowest starting total on the DL in years.

It's a bit worrisome that baseball's insurer doesn't know the rules of the game, but it's more worrisome that we don't have better answers. While some in the game like Stan Conte search for answers, there's too many that throw their hands up and their money away, wasting days, dollars, talent and opportunity to injuries.

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In yesterday's comments, subscriber Gerald Burris had an interesting question:

"In the case of Hanley, or even moreso Pujols, does an abundance of mostly minor injuries early in a career, that the athlete is mostly able to play through with little adverse effect, indicate anything for the later years of their career? Does it suggest a talent for playing through minor maladies without succumbing to major DL stretchs that should be repeatable through their later years? Or might the knicks add up over time and result in a more precipitous decline?"

This would be one of those places where an accurate historical database of injuries would come in handy. Failing that, let's use the BP "hivemind" relying on all of you out there: Do players come to mind that follow this pattern? Why? The results of their careers are pretty easy to find, but if one comes to mind, put it in today's comments.

Randy Johnson (45 DXL)
There's always going to be a question as to whether Johnson should have been allowed to go out and pitch after straining his shoulder while batting. There are players, usually elder statesmen like Johnson, that get some leeway. Johnson also has to get some extra slack since he's dealing with so many back issues that the medical staff has to trust him more than most. Still, those few pitches not only cost the team that one game, it might also perhaps cost more. With the Giants riding their pitching to wild-card contention, losing Johnson for up to six weeks could cost them one win in value. Johnson's shoulder strain is the first significant arm injury of his career, though he certainly knows how to rehab, given his back and knee problems. Johnson thinks it will take up to eight weeks, but that was Johnson talking, not the medical staff. Given what we know, the initial velocity loss, and Johnson's history, he might not be wrong, but I think it will be more like six weeks.

Ryan Dempster (25 DXL)Aramis Ramirez (0 DXL)
Jayson Stark owns the rights to the ridiculous injury story, so I hope I'm not infringing while laughing and shaking my head at Dempster's injury. Injuries are seldom funny, and losing Dempster for a month certainly isn't going to make the Cubs laugh, but jumping over the railing to celebrate a game in July? Dempster won't miss much time once the broken big toe has healed, since he'll be able to keep his arm in shape to some extent while protecting the toe. The bigger concern is making sure that the toe heals enough that his mechanics aren't affected when he does return. The Cubs used Carlos Zambrano on short rest as a replacement, and seemed to make the best of a potentially very bad situation, though his velocity was still down from the norm. The Cubs are also watching Ramirez, who's been solid in both the minors and majors since his shoulder healed. There's been a lot of media buzz about re-injury risk, but I want to note that this was a re-injury, in ways, for Ramirez, who's had a chronically lax shoulder since he came into the league. Ramirez is at no elevated risk compared to where he was before the flukish injury on a fielding play.

Carlos Beltran (45 DXL)
On the day when Jose Reyes is getting another cortisone shot in his knee-what, did the Mets buy their cortisone at Costco this year?-there's even more bad news. Not only is Beltran not doing "baseball activities," he's not even doing anything weight-bearing when possible. There's some wiggle room here in what two sources tell me that I can't get the solid grasp on, but Beltran doesn't appear to be doing anything that adds anything more than his own body weight (or to say another way, added force) to his troublesome knee. He's not on crutches, but he's definitely not running or doing anything more than keeping up his cardio on a stationary bike. He can walk, but even that is said to be painful. There's almost no doubt that he's headed for some kind of surgery, but whether that comes after the season is the thing the Mets are still trying to determine. Losing either Reyes or Beltran would put a big damper on any playoff plans, but right now, the Mets are relying on both to come back on schedule. That's after the break for Reyes and early August for Beltran; any deviation for one may well change the plans for the other.

Mark DeRosa (40 DXL)
You wouldn't think that Mark DeRosa and David Ortiz would have much in common. Sure, they're both baseball players, but not similar in style or skill. I think both would rather that they didn't share a common injury, the torn tendon sheath in their wrist. It's one that is both painful and lingering, but DeRosa's not a power-only guy. Unlike Ortiz, he can go up there and be a bit slappy and still be effective. The wrist won't affect him in the field or on the bases, so this isn't as devastating an injury for him as it was last year for Ortiz. It's still not good, though and DeRosa is looking at anywhere from four to eight weeks off. (Ortiz was out seven weeks, for the record, and certainly affected the rest of the season.) I'd guess the low end of that, coming back in early August. Cards fans are already e-mailing asking if the trade can be voided; the answer is a simple 'no.' DeRosa doesn't seem to have any pre-existing indications, let alone the injury itself, and they passed him on his physical when accepting him. This is just bad luck on the Cards' part, and they'll just have to regroup around what looked like a great acquisition.

Hanley Ramirez (10 DXL)
Ramirez should be on the DL. Yes, that's the kind of blanket statement that someone outside of the training room shouldn't make, but bear with me here. Ramirez has spent most of the season fighting some sort of leg injury, most recently the strained hip flexor that has him hobbled and out of the lineup. His latest injury has kept him out of the lineup over the weekend, a smart move given his value and how he was moving prior to the rest. With a handful of games between now and the All-Star break, it simply makes sense, perhaps more than any other time of the season, to leverage those offdays and get Ramirez back quickly. Sure, if he's able to play on Tuesday at full-go speed, he should do it, but it would be nice to have five games off for Ramirez, as he's as valuable an asset as the Marlins have. The medical staff will have to balance their responsibilities with the extra days. Remember that the DL works on days, not games, meaning those three or four days of the break make a big difference in a DL/No DL situation.

David Eckstein (15 DXL)
The Padres finally decided to put Eckstein on the DL. First, his hamstring wasn't getting better, even with a week of rest and treatment. Second, the All-Star break puts pressure on teams that are on the fence about players; as we're seeing with Hanley Ramirez above, the time all teams are about to get off factors into their decision-making. Eckstein should be back at or near the minimum, but what he comes back to remains to be seen. The Padres will have to make a decision on how much Eckstein adds over getting what might be a glance at their middle infield next year over the last week.

Rick Porcello (0 DXL)Joel Zumaya (0 DXL)
The Tigers have the lead, but how they handle their pitching over the next couple of months might matter as much for their chances of winning in 2010 and 2011 as much as it does in 2009. Not only do they have to balance the "win now" with "keep Rick Porcello's arm attached to his body," they have to find ways to keep him effective this year. Porcello has already thrown almost 90 innings this season, so even with things like skipping his next turn and finding extra rest, he's still looking at 160 innings or so on the low end. This in his second year as a pro, in his age-20 season. If the Dwight Gooden comparison doesn't pop into your head-and given the vast difference in how we work pitchers today, maybe it shouldn't-all the Tigers need as a reminder as far as the risks is sitting on their bench, rehabbing his own arm. Porcello is essentially Jeremy Bonderman 2.0, a young, very talented pitcher who was monitored closely and still managed to hurt himself. Even while doing all the right things, the strain of a normal workload on a young pitcher's arm is tough to survive. The Tigers also have to watch Joel Zumaya closely. After a 53-pitch outing, his velocity and effectiveness have been way off. The team thinks he just needs more rest, but they will try to monitor his usage more tightly. With Zumaya, I'm not sure if he's not so fragile that it's worth taking the gloves off and trying to maximize his value before he explodes, BJ Ryan-style.

Vladimir Guerrero (7 DXL)
The late game in Anaheim didn't go well for the Angels, as they lost the game, their division lead, and Vladi. Guerrero was playing an easy single, setting up for the throw and... well, look for yourself. Guerrero calf acted up, he grabbed it quickly, and when he went down he stayed down. Coming off of surgery on his right knee and the torn pectoral muscle that cost him the start of the season, this is just another in incident in what looks like a rapid descent towards the end of his career. The injury itself doesn't seem that significant; the team will wait to see how it's feeling today and how it responds to treatment before they even consider the DL, using the All-Star break to give them some time.

Quick Cuts: Yes, I wrote for this year's Football Outsiders Almanac, including an article on the rehab process. It's specific to football, but the process is the same across sports. ... Johnny Cueto insists that he's fine physically after getting crushed by the Phillies. He could be out on short rest this week after going less than an inning in hopes of rebuilding some confidence. His velocity was pretty good, but the control has been slipping. Is it his elbow? Maybe. ... Chipper Jones has a mild groin strain and might miss a couple of games. Then again, it's Chipper Jones, so he'll probably just play through it, hurt himself, and then miss a couple of games. ... Carlos Guillen took batting practice for the first time since May, but he's "not close" to a return. ... Richard Justice has an interesting note about Roy Oswalt adjusting his mechanics. ... Ronald Belisario is headed for an MRI on his elbow and a visit to Neil ElAttrache. The surprising Dodgers reliever previously had Tommy John surgery, and I always worry about these "out of nowhere" guys. ... Carlos Delgado is hitting off of a tee and on a TRIP with his hip. ... Angel Pagan started a rehab assignment and should be back this weekend. What, I thought Mets fans wanted good news. ... Billy Wagner should be back around August 20th, assuming no setbacks in his return from Tommy John. I'm told his velocity is already "up there." ... I'll also have an announcement soon about the oft-rumored Carroll Guide to Sports Injuries.

Its really too bad. If you had told me that we would sign Gary Sheffield for minimum and he would have a .314 eqa with maybe 500 pa's and that Jimmy Rollins was hitting this way and Myers was out for the season in march I would have said that we could get away with losing one of our stars. And we could have. Just not two of them, plus delgado. And why am I not elated for the return of Big Game Ollie.

On the Porcello/Bonderman comp, though he's hurt now, and perhaps has never been as good as some hoped, Bonderman did give the Tigers four straight years of 180+IP with an ERA under 5. Not an all-star, that, but certainly a very valuable commodity. As his fantasy owner, I certainly want more from Porcello, but Bonderman hardly seems a worst-case outcome for the Tigers.

Shame about Beltran, does this to you, sound more and more like the injury that keeps him in the "Hall of Very Good" rather than heading to upstate New York in 2020?

Another thing about Randy Johnson going back out to pitch after injuring his shoulder on the swing--he had to make a tough throw after fielding a tapper; he ended up throwing it into right field. That could have caused some damage as well.

As an Indians fan, Carlos Baerga comes to mind as a guy who rarely missed time. I don't remember a ton of talk about injuries, but it's hard to imagine any second baseman not fighting little nags constantly.